Analisi Schede di Dimissioni Ospedaliere
| Marco Gaudio |
22 maggio, 2021
The aim of this document is to analyze the data related to the italian Schede di Dimissioni Ospedaliere (SDO), in the period 2016 - 2019. The data are provided by the Italian Ministry of Health.
The document is composed by 4 sections:
section 1 provides an analysis for each of the 5 activities (Acuti Regime ordinario; Acuti Regime diurno, Riabilitazione Regime ordinario; Riabilitazione Regime diurno; Lungodegenza) and considering the differences in the period studied.
section 2 analyses the hospitalization rates, first providing an overview for Italy as a whole, and then analysing the rates for each of the 5 activities in in the period 2016-2019, considering different regions, gender and age categories.
section 3 gives an overview of the Italian and English population in 2019, then an analysis of England’s total number of surgeries (that can be compared to the total number of the italian “dimissioni”) and surgical incidences (the italian “tasso di ospedalizzazione”) is made. Lastly, it shows a comparison between the overall hospitalization rates in Italy and England, thanks to the data provided by the Health and Social Care Information Centre, now called NHS Digital.
section 4 proposes an analysis of the data about hospitalization discharges collected from two different sources: Istat and Italian Ministry of Health.
An overview of hospitalization discharges in Italy
The following graph shows the total number of hospital discharges divided by activity for the 4 years of analysis.
Table 1.1.1 shows the total number of discharges for all the activities and its percentage variation through the period of analysis. As shown here, the total number of hospital discharges is decreased from 2016 to 2019. In particular, from 2018 to 2019 the number has dropped from 8.356.874 to 8.212.031, with a decrease of 1.733%.
1 ATTIVITÀ
1.1 Acuti - Regime ordinario.
the following section is aimed to analyze the discharge in Acuti - Regime ordinario, from 2016 to 2019 in Italy.
1.1.1 DIMISSIONI
Table 1.1.2 provides a summary of the hospedalization discharges in “Acuti - Regime ordinario” and the percentage variation year by year.
This bar chart shows the hospital discharges by MDC for each year of the analysis.
As shown from the bar chart, over the 4 years of analysis, the MDC class with the greatest number of discharges for the activity Acuti - Regime ordinario is the MDC 05 - Malattie e disturbi dell’apparato cardiocircolatorio, followed by MDC 08 - Malattie e disturbi del sistema muscolo-scheletrico e del tessuto connettivo and MDC 04 - Malattie e disturbi dell’apparato respiratorio.
The following table provides a summary of the discharges for each MDC class and for each year.
1.1.2 PERCENTUALE GIORNI DIMISSIONI PER MDC.
The following pie charts show the number of days before discharge in percentage for the 4 years analysed. As shown, the highest percentage of discharges for the activity Acuti - Regime ordinario is DIMISSIONI TRA 4 GIORNI E VALORE SOGLIA, with 55.6%. This means that 55.6% of the hospitalization discharges in this activity lasts between 4 days and the treshold value (Valore Soglia).
The bar chart below shows the distribution of discharges in Acuti - Regime ordinario per age category, for each year of analysis.
The following table provides a summary of the data presented about hospitalization discharges by age category.
1.1.3 GIORNATE DI DEGENZA
The following graph shows the “Giorni di Degenza” for each MDC and over the years of analysis. 
Table 1.1.5 provides a summary for Giorni di Degenza by MDC for each year.
The following graph shows the Mean value for Giorni di Degenza, for each MDC and for each year.
2019
2018
2017
2016
Table 1.1.6 provides a summary of Max, Min and Mean values for “Giorni di Degenza” for each MDC.
1.2 Acuti - Regime diurno.
1.2.1 DIMISSIONI
Table 1.2.1 provides a summary of the hospedalization discharges in “Acuti - Regime diurno” and the percentage variation year by year. As shown, there has been a decrease in the hospitalization discharges in this activity, in particular from 2016 to 2017, with a reduction of 6.71%.
This bar chart shows the hospital discharges by MDC for each year of the analysis.
In the case of Acuti - Regime diurno, over the 4 years of analysis, the MDC class with the greatest number of discharges is the MDC 08 - Malattie e disturbi del sistema muscolo-scheletrico e del tessuto connettivo, followed by MDC 17 - Malattie e disturbi mieloproliferativi e neoplasie scarsamente differenziate and MDC 13 -Malattie e disturbi dell’apparato riproduttivo femminile.
The following table provides a summary of the discharges for each MDC class and for each year.
The bar chart below shows the distribution of discharges in Acuti - Regime diurno per age category, for each year of analysis.
The following table provides a summary of the data presented about hospitalization discharges by age category.
1.2.2 ACCESSI
The following graph shows the Accessi for each MDC and over the years of analysis.
These bar charts shows the mean for the variable Accessi by each MDC and for the 4 years of analysis.
2019
2018
2017
2016
Table 1.2.4 provides a summary of Max, Min and Mean values for “Accessi” for each MDC.
1.3 Riabilitazione - Regime ordinario.
1.3.1 DIMISSIONI
Table 1.3.1 provides a summary of the hospedalization discharges in “Riabilitazione - Regime ordinario” and the percentage variation from year to year. There is a reduction in the number of discharges from 2016 to 2018, then a slight increase in 2019. None of these is very significant.
This bar chart shows the hospital discharges by MDC for each year of the analysis. 
There are just a few MDC classes with a considerable number of discharges in Riabilitazione - Regime ordinario. These are: MDC 08 - Malattie e disturbi del sistema muscolo-scheletrico e del tessuto connettivo; MDC 01 - Malattie e disturbi del sistema nervoso; MDC 05 - Malattie e disturbi dell’apparato cardiocircolatorio.
Table 1.3.2 provides a summary of the discharges for each MDC class and for each year.
The bar chart below shows the distribution of discharges in Riabilitazione - Regime ordinario per age category, for each year of analysis.
The following table provides a summary of the data presented about hospitalization discharges by age category.
1.3.2 GIORNATE DI DEGENZA
The following graph shows the Giorni di Degenza for each MDC and over the years of analysis.
Table 1.3.4 provides a summary for Giorni di Degenza by MDC for each year.
The following graph shows the Mean value for Giorni di Degenza for each MDC.
2019
2018
2017
2016
Table 1.3.5 provides a summary for the mean value for “Giorni di Degenza”, for each MDC.
1.4 Riabilitazione - Regime diurno.
1.4.1 DIMISSIONI
Table 1.4.1 provides a summary of the hospedalization discharges in “Riabilitazione - Regime diurno” and the percentage variation from year to year. As shown, there has been an important decrease in hospitalization discharges in between 2017 and 2018 (-6.745%).
This bar chart shows the hospital discharges by MDC for each year of the analysis.
In the case of activity Riabilitazione - Regime diurno, there are a few MDC with a considerable level of discharges: MDC 01 - Malattie e disturbi del sistema nervoso; MDC 08 - Malattie e disturbi del sistema muscolo-scheletrico e del tessuto connettivo; MDC 23 - Fattori che influenzano lo stato di salute ed il ricorso ai servizi sanitari.
The following table provides a summary of the discharges for by MDC class and for each year of the analysis.
The bar chart below shows the distribution of discharges in Riabilitazione - Regime diurno per age category, for each year of analysis.
The following table provides a summary of the data presented about hospitalization discharges by age category.
1.4.2 ACCESSI
The following graph shows the Accessi for each MDC and over the years of analysis.
Table 1.4.4 provides a summary for Accessi by MDC for each year.
The following graph shows the Mean value for Accessi for each MDC.
2019
2018
2017
2016
Table 1.4.5 provides a summary for the mean value for Accessi for each MDC.
1.5 Lungodegenza.
1.5.1 DIMISSIONI
Table 1.5.1 provides a summary of the hospedalization discharges in Lungodegenza and the percentage variation year by year.
This bar chart shows the hospital discharges by MDC for each year of the analysis.
As shown from the bar chart, over the 4 years of analysis, the MDC classes with the greatest number of discharges for the activity Lungodegenza are: MDC 08 - Malattie e disturbi del sistema muscolo-scheletrico e del tessuto connettivo; MDC 01 - Malattie e disturbi del sistema nervoso; MDC 04 - Malattie e disturbi dell’apparato respiratorio.
The following table provides a summary of the discharges for each MDC class and for each year.
The bar chart below shows the distribution of discharges in Lungodegenza per age category, for each year of analysis.
The following table provides a summary of the data presented about hospitalization discharges by age category.
1.5.2 GIORNATE DI DEGENZA
The following graph shows the Giorni di Degenza for each MDC and over the years of analysis.
Table 1.5.4 provides a summary for Giorni di Degenza by MDC for each year.
The following graph shows the Mean value for Giorni di Degenza for each MDC.
2019
2018
2017
2016
Table 1.5.4 provides a summary for the mean value for “Giorni di Degenza” for each MDC.
2 TASSI DI OSPEDALIZZAZIONE
2.1 Overview in Italia
2.1.1 TASSO DI OSPEDALIZZAZIONE IN ITALIA PER ATTIVITÀ
The following bar chart shows the evolution of the Tasso di ospedalizzazione in Italy in the period of analysis. As shown by the graph, there has been a decrease in the hospitalization rates per 1000 inhabitants, in particular for the activity “Acuti - Regime ordinario” (from 101.624 in 2016 to 97.611 in 2019).
Table 2.1.1 provides an overview on the hospitalization rates (per 1000 inhabitants) in Italy during the period 2016-2019.
2.1.2 TASSI DI OSPEDALIZZAZIONE PER GENERE
The graph below shows the hospitalization rates in Italy per gender and for the different activities. In this case, there has been a small reduction for both gender and for all the activities.
Table 2.1.2 provides a summary for the data about hospitalization rates by gender in Italy.
2.1.3 TASSO DI OSPEDALIZZAZIONE PER CATEGORIA DI ETÀ ED ATTIVITÀ
The following graph represents the evolution of the hospitalization rates by age category in Italy and for each activity.
Table 2.1.3 provides the summary for the hospitalization rates in Italy by age category.
2.2 Acuti - Regime ordinario
Table 2.2.1 shows the hospitalization rates for the activity Acuti - Regime ordinario for the 4 years of analysis and the corresponding percentage variation. A 1.998% reduction in the hospitalization rates occurred between 2018 and 2019.
2.2.1 TASSO PER CATEGORIE DI ETÀ
As shown by the graph, through the years of analysis the hospitalization rates by age category have a little drop for the activity Acuti - Regime ordinario.
Table 2.2.2 represents the data about hospitalization rates for age category in Acuti - Regime ordinario for each year.
2.2.2 TASSO PER REGIONE E SESSO
The following graphs show the evolution of the hospitalization rate in Italy by region and gender in the period 2016-2019. The horizontal blue line displays the hospitalization rates in all Italy for the male gender, the red one for the female gender.
Table 2.2.3 shows the hospitalization rate for each region, by gender and year, for the activity Acuti - Regime ordinario.
2.2.3 TASSO PER TIPO DRG
The following section shows the evolution of the hospitalization rates per 1000 inhabitants for the activity Acuti - Regime ordinario by DRG type. Indeed, the type of DRG could be “C”, that stands for “CHIRURGICI”, or “M”, that means “MEDICI O NON CLASSIFICABILI”. The distiction between the two is that the first DRG is characterised by the presence of surgery or other “significant” procedure, while the second one considers DRG with diagnostic or therapeutic procedures with no need of operating room. As shown by the graph, the incidence of DRG type “M” is higher. For example, in 2019 there has been around 56 discharges per 1000 inhabitants for DRG with diagnostic or therapeutic procedures with no need of operating room(type “M”), while the incidence for the discharges characterized by DRG that required surgery(type “C”) is around 44 discharges per 1000 inhabitants in the same year.
The table below shows in detail the hospitalization rates previously discusssed and represented.
2.3 Acuti - Regime diurno
Table 3.1.1 shows the hospitalization rates for the activity Acuti - Regime diurno for the 4 years of analysis and the corresponding percentage variation. An important decrease occurred in between 2016 and 2017 (-6.588%). The rate is decreasing over the 4 years of analysis.
2.3.1 TASSO PER CATEGORIE DI ETÀ
The graph below shows that through the years of analysis the hospitalization rates by age category is decreased for all the age categories for the activity Acuti - Regime diurno.
Table 3.1.2 represents the data about hospitalization rates for age category in Acuti - Regime diurno for each year.
2.3.2 TASSO PER REGIONE E SESSO
The following graphs show the evolution of the hospitalization rate in Italy by region and gender in the period 2016-2019. The horizontal blue line displays the hospitalization rates in Italy for the male gender, the red one for the female gender.
Table 3.1.3 shows the hospitalization rate for each region, by gender and year, for the activity Acuti - Regime diurno.
2.3.3 TASSO PER TIPO DRG
The following section shows the evolution of the hospitalization rates per 1000 inhabitants for the activity Acuti - Regime diurno by DRG type. In this activity, the incidence of DRG type “C” is higher. For example, in 2019 there has been around 17 discharges per 1000 inhabitants for DRG that required surgery (type “C”) while dischages of DRG with diagnostic or therapeutic procedures with no need of operating room(type “M”) have been around 12 per 1000 inhabitants in the same year.
The table below shows in detail the hospitalization rates previously discusssed and represented.
2.4 Riabilitazione - Regime ordinario
Table 4.1.1 shows the hospitalization rates for the activity Riabilitazione - Regime ordinario for the 4 years of analysis and the corresponding percentage variation. The hospitalization rate is decreasing over time.
2.4.1 TASSO PER CATEGORIE DI ETÀ
As shown by the graph, through the years of analysis the hospitalization rates remained stable for some of the age categories, while decreased for others, in particular for the categories: “Da 65 a 74 anni” and “75 anni e oltre” for the activity Riabilitazione - Regime ordinario.
Table 4.1.2 represents the data about hospitalization rates for age category in Riabilitazione - Regime ordinario for each year.
2.4.2 TASSO PER REGIONE E SESSO
The following graphs show the evolution of the hospitalization rate in Italy by region and gender in the period 2016-2019. The horizontal blue line displays the hospitalization rates in Italy for the male gender, the red one for the female gender.
Table 4.1.3 shows the hospitalization rate for each region, by gender and year, for the activity Riabilitazione - Regime ordinario.
2.5 Riabilitazione - Regime diurno
Table 5.1.1 shows the hospitalization rates for the activity Riabilitazione - Regime diurno for the 4 years of analysis and the corresponding percentage variation. An important reduction in the hospitalization rate is occurred in between 2017 an 2018 (-6.986%). The rate is decreasing until 2018, then there has been a little increase.
2.5.1 TASSO PER CATEGORIE DI ETÀ
As shown by the graph, through the years of analysis the hospitalization rates is increased for some of the age categories (“Da 1 a 4 anni” and “Da 5 a 14 anni”) and it is decreased for some others (“Da 45 a 64 anni”; “Da 65 a 74 anni” and “75 anni e oltre” ) for the activity Riabilitazione - Regime diurno.
Table 5.1.2 represents the data about hospitalization rates for age category in Riabilitazione - Regime diurno for each year.
2.5.2 TASSO PER REGIONE E SESSO
The following graphs show the evolution of the hospitalization rate in Italy by region and gender in the period 2016-2019. The horizontal blue line displays the hospitalization rates in Italy for the male gender, the red one for the female gender.
Table 5.1.3 shows the hospitalization rate for each region, by gender and year, for the activity Riabilitazione - Regime diurno.
2.6 Lungodegenza
Table 6.1.1 shows the hospitalization rates for the activity Lungodegenza for the 4 years of analysis and the corresponding percentage variation. A huge decrease occurred between 2016 and 2017 (-5.306%).
2.6.1 TASSO PER CATEGORIE DI ETÀ
The graph below shows that the hospitalization rate is almost 0 for the earlier age categories and is much higher for the last ones. Through the years of analysis the hospitalization rates decreased for these latter categories for the activity Lungodegenza.
Table 6.1.2 represents the data about hopspitalization rates for age category in Lungodegenza for each year.
2.6.2 TASSO PER REGIONE E SESSO
The following graphs show the evolution of the hospitalization rate in Italy by region and gender in the period 2016-2019. The horizontal blue line displays the hospitalization rates in Italy for the male gender, the red one for the female gender.
Table 6.1.3 shows the hospitalization rate for each region, by gender and year, for the activity Lungodegenza.
3 CONFRONTO TASSI OSPEDALIZZAZIONE: ITALIA vs INGHILTERRA
This section gives an overview of the Italian and English population in 2019, then an analysis in England of the total number of surgeries (that can be compared to the total number of the italian “dimissioni”) and surgical incidences (the italian “tasso di ospedalizzazione”) in 2012 is made. Lastly, it shows a comparison between the overall hospitalization rates in Italy (2019) and England (2012).
3.1 Popolazione: Italia vs Inghilterra
This first part shows the differences between English and Italian population in 2019, considering age category and gender. Data about population are provided by Istat for Italy and UK Office for National Statistics for England. Note that for this latter, the population used in computing the surgical incidences is the one of 2012.
Table 3.1.1 summarises the data about the italian and english population in 2019, by age category and gender. The total population is 59.816.673, where 29.131.195 are male and 30.685.478 female. In England the total population in 2019 is 56.286.961, where 27.827.831 are male and 28.459.130 female.
3.2 Numero di interventi e tassi di ospedalizzazione in Inghilterra per categoria di età.
The data collected for England about hospitalization rate consider two main activities, In-patient surgeries and Out-patient surgeries. The difference between the two is that the first one requires overnight hospitalization, while patients receiving out-patient care don’t need to spend a night in a hospital. These two activities can be compared respectively to the italian Ricovero Ordinario and Day-hospital.
The following graph shows the total number of surgeries in England (In-patient and Out-patient) by age category and gender. 
Table 3.1.2 summarises the data of the graph above.
The following graph shows the the hospitalization rate in England for age category and gender, considering both In-patients and out-patients surgeries. It has to be noticed that these hospitalization rates take into account only of hospitalizations discharges that involved a surgical procedure.
Table 3.1.3 shows the data about surgical incidences represented in the graph above
3.3 Tassi di ospedalizzazione: Inghilterra vs Italia
The following graph provides an overview of the differences between the hospitalization rate in England (2012) and in Italy (2019) by age. As previously mentioned, the rates of England are surgical incidences, so they refer to hospitalization discharges that involved surgery. For this reason, to make a comparison with Italy, it is needed to take for this latter the hospitalization discharges with “C” as type of DRG.
Table 3.1.4 shows the data about hospitalization rate represented in the bar chart above.
4 CONFRONTO DATI DIMISSIONI OSPEDALIERE: ISTAT VS MINISTERO DELLA SALUTE
The following section provides a comparison between the data about hospitalization discharges in 2019 collected from two different sources: Istat and Italian Ministry of Health.
Istat provided data just for the activity Acuti, distinguishing between “Ordinario” and “Day-Hospital”, that are respectively given by Acuti - Regime ordinario and Acuti - Regime diurno from Ministry of Health.
As shown by the table above, there is a slight difference in the data provided by the two sources for both Regime ordinario and Regime diurno.
4.1 Istat, Acuti - Regime ordinario
This part focuses on the analysis of hospitalization discharges for the activity “Acuti - Regime ordinario” considering data provided by istat. In the data provided by istat, the age categories are a very limited number compared to the ones of Italian Ministry. This is shown in the graph below.
Table 4.1.2 provides a summary of the hospitalization discharges by age category in 2019 in Italy.
Data provided by Istat consider the distinction between hospitalization discharges by gender, as well as data provided by Italian Ministry of Health. As shown by the graph below, the numbers are slightly different due to the fact that the Italian Ministry data, in distinguishing between male and female, does not consider discharges where age or gender were not well specified.
An important difference in data provided by istat is the distinction between country of origin of the patient, as shown in the graph below.
The pie chart below shows the geographical area of the patient without discriminate by age category. As shown, the discharges of people from Oceania and people that are stateless (Apolide) are negligible. The most important proportion of the table is, of course, by patients of Europe. This is due to the fact that the number of discharges of Italian people is the highest, namely 5.615.223.
The following table summarises the data shown in the graphs above.
4.2 Istat, Acuti - Regime diurno
This second part is concerned to the analysis of hospitalization discharges for the activity “Acuti - Regime diurno” considering data provided by istat.
This first graph shows the hospitalization discharges taking into account the different age category.
Table 4.1.4 provides a summary of the hospitalization discharges by age category in 2019 in Italy.
Data provided by Istat consider the distinction between hospitalization discharges by gender, as well as data provided by Italian Ministry of Health. Even in the case of Acuti - Regime diurno the numbers are slightly different due to the fact that the Italian Ministry data, in distinguishing between male and female, does not consider discharges where age or gender were not well specified.
An important difference in data provided by istat is the distinction between country of origin of the patient, as shown in the graph below.
The pie chart below shows the geographical area of the patient without discriminate by age category for Acuti - Regime diurno. Even in this case, the discharges of people from Oceania and people that are stateless (Apolide) are negligible. The most important proportion of the table is, of course, by patients of Europe. This is due to the fact that the number of discharges of Italian people is the highest, that is 1.647.029.
The following table summarises the data shown in the graphs above.
4.3 Tasso di ospedalizzazione per l’attività Acuti: dati Istat vs Ministero della Salute
The following paragraph focuses on the differences in the overall hospitalization rate considering the two different data sources (Istat and Ministero della Salute) in Italy in 2019 for the activity Acuti, so, considering the sum of discharges in Regime ordinario and Regime diurno.
This table shows the hospitalization rates per 1000 inhabitants(Italy, 2019), considering the two different data sources, for the activity Acuti (taking into account of the discharges in Regime ordinario and Regime diurno). As shown, the difference is particularly small. Indeed, the number of disharges is almost the same in considering the two sources.
GLOSSARIO
Accessi: presence in hospital without overnight stay, for the provision of day-hospital benefits. The number of Accessi refers to the number of days where the patient went to the facility to receive the service. Indeed, in case of day-hospital regime, every single daily access for the entire treatment period is counted as giornata di degenza and the date of discharge corresponds to the date of the last contact with the institution.
Attività: type of hospital care; it includes: ricoveri per acuti, riabilitazione and lungodegenza.
Day Hospital (diurno): characterized by: programmed hospitalization; it is limited to part of the day, it does not include overnight staying; it provides multiprofessional or plurispecialistic services that require a running time that deviates sharply from that necessary for a normal outpatient performance.
DRG – DIAGNOSIS RELATED GROUP: category of hospital admissions defined in such a way that they have similar clinical characteristics and require homogeneous volumes of hospital resources for their treatment. The following information is required to assign each admission episode to a specific DRG: the main diagnosis of discharge, all secondary diagnoses, all surgical procedures and the main diagnostic and therapeutic procedures, age, sex and mode of discharge. The attribution is carried out using an algorithm that analyzes the above information and determines the group to which it belongs.
Giorno di Degenza: period of 24 hours during which a bed is occupied.
MDC - MAJOR DIAGNOSTIC CATEGORY (MDC): the DRG system provides a higher level of grouping based on a criterion of clinical relevance (anatomical or etiological): based on the main diagnosis reported in the Scheda di Dimissione Ospedaliera, the MDC category is assigned; subsequently, a specific DRG is assigned among those belonging to the selected MDC.
Ricoveri di Lungodegenza: these are the admissions of patients discharged from departments belonging to the LUNGODEGENTI discipline.
Regime di ricovero: distinguishes between “RICOVERO ORDINARIO”, that requires for overnight stay in the hospital, and “RICOVERO IN DAY HOSPITAL”,characterized by the presence in hospital just for a part of the day.
Ricoveri per Acuti: all cases of discharges from departments other than those classified as rehabilitative or long-term; healthy infants are also excluded.
Ricoveri di Riabilitazione: identified as admissions of patients discharged from departments belonging to the disciplines: UNITA’ SPINALE, RECUPERO E RIABILITAZIONE FUNZIONALE, NEURORIABILITAZIONE, and hospitalization in rehabilitation institutions only (LUNGODEGENZA excluded).
Ricovero Ordinario: provides for the allocation of a bed and the continuous stay of the patient with overnight stay in the hospital.
Tasso di ospedalizzazione: the hospitalization rate provides a summary measure on the use of hospitalization of the population under study. It is calculated as the ratio of the number of hospitalizations, everywhere carried out, relating to persons resident in a given region, and the total population resident there.
Valore Soglia: value of stay duration, specific for each DRG, above or below which a stay in Regime ordinario is considered “abnormal for the duration of the stay”.